What’s the deal with Overactive Let-down?

To those of you new to breastfeeding, overactive let-down (OALD) is the forceful ejection of milk from the breast during breastfeeding.

Most breastfeeding issues get lots of press. The sore and engorged breasts, chafed nipples, bad latches that can lead to blocked ducts and mastitis. But breastfeeding can still take you by surprise, as I learnt “on the job”.

Around week 3 of breastfeeding, all was going as well as could be expected. My breasts were making lots of milk, I was leaking everywhere but the baby’s latch was good and she was gaining weight. But I started noticing that she was very gassy and fussy, along with a few other things:

She would gag, choke, gulp and gasp while nursing as though the milk is coming too fast. This would happen at every feed.

She would arch her back away from me, pulling off the breast while nursing, and sometimes refuse to latch back on the same breast.

She would clamp down on the nipple at letdown and make a clicking sound while nursing.

She sometimes projectile vomited, and her poops can only be described as “explosive”.

She would make grunting noises in her sleep. She would pull her knees up to her chest, and only passing gas would make her comfortable again.

While some babies comfort nurse for hours, my baby nursed for five minutes. Every. Single. Time.

There were many wet diapers and frequent poops, usually explosive. Sometimes the stools were green and frothy.

If you’re nodding your head at the symptoms above then high five, you (and me) have an overactive or forceful letdown. This is when milk is ejected at such a high pressure and such great quantity from the breast that the baby can’t keep up. This could be because mothers generally make a lot of milk in the beginning since her body has no idea how much the baby needs yet.

While your breasts eventually adjust to tailor make the perfect amount of milk for baby, this could take up to 6 weeks and could result in many uncomfortable nights. Babies end up gassy and fussy and sometimes even go on strike, refusing the breasts altogether. This is super painful for nervous new moms especially as you feel like you’ve failed, and you don’t even know why!

Here are some things you can try to manage an overactive letdown:

1. Burp baby frequently.

2. Nurse in a different position “uphill” or sideways. Side lying helped me a lot as baby could allow the excess milk to dribble out of her mouth. Dream feeding is

3. Wait for letdown, then unlatch the baby to catch the spray of milk on a cloth. This worked as well, but I had to introduce a pacifier to keep her calm. Another great way to get your breasts to adjust in a hurry is block feeding. That means using only one breast per feed.

4. Let baby nurse on that breast as much as she wants. If you get really sore in the other breast, you can express a little and offer it to her on the next feeding. If you have a really severe case of overactive letdown, as I did, you will want to try using the same breast over a period of 4 hours.

5. Try not to pump in the first 6 weeks if you can, as that really aggravates the oversupply.

6. Most importantly, keep direct latching on demand. Introducing bottles to a baby who already does not like comfort nursing may lead to an undesired early weaning. Just try, try and try, eventually both baby and breasts will adjust.

My baby today still only takes one breast at a time but deals really well with the letdown. She simply pops off when the spraying starts, then pops on again, all giggles and no drama!